New poll finds the majority of GPs would like the choice of assisted dying to be available to them or did not discount it

Press release|17th June 2014

“This polling shows that GPs aren’t as far behind public opinion as opponents to assisted dying would have us believe. 80% of the general public support the change in the law put forward by Lord Falconer, and 65% of GPs would either want that choice to be available for themselves, or are currently unsure.”

As an Assisted Dying Bill has been presented to the House of Lords, to be debated on 18th July 2014, new research finds that the majority of GPs either would like the choice of assisted dying to be made available to them, or were unsure and did not rule it out. The poll of 878 GPs in England and Wales found 40% would want the choice of an assisted death if they were terminally ill, 25% were unsure, and 32% would not personally want the choice.

The poll also found that the majority (61%) of GPs across England and Wales felt that the representative medical bodies, such as the British Medical Association and the Royal College of GPs should be neutral on the issue. Currently both of these medical bodies, and many others, hold a position of opposition to a change in the law.

“This polling shows that, while GPs are divided on the issue of assisted dying, many would like the choice to be available. We also know that around one percent of GPs’ patients are nearing the end of their lives. As a GP, I would certainly have liked to have known that when a competent dying patient, suffering at the end of their life, asked me for help to die, that within safeguards I could have provided that patient with the support and necessary medication so that they could have what they considered to be a good death, at home and surrounded by their loved ones.

Sarah Wootton, Chief Executive if Dignity in Dying said:

“This polling shows that GPs aren’t as far behind public opinion as opponents to assisted dying would have us believe. 80% of the general public support the change in the law put forward by Lord Falconer, and 65% of GPs would either want that choice to be available for themselves, or are currently unsure.

“Without a change in the law terminally ill patients will continue to take decisions without adequate safeguards, whether by travelling to Switzerland to die, ending their lives themselves, or being illegally helped to die by doctors. This law will not result in more people dying, but it will result in fewer people suffering.”

• Dignity in Dying campaigns for greater choice, control and access to services at the end of life. It advocates providing terminally ill adults with the option of an assisted death, within strict legal safeguards, and for universal access to high quality end-of-life care.
• Dignity in Dying has over 25,000 supporters and receives its funding entirely from donations from the public.

medeConnect Healthcare Insight surveyed 1005 UK GPs (878 in England and Wales) between 14th-20th May 2014. medeConnect is the market research division of doctors.net.uk

The Assisted Dying process and healthcare professionals

Doctors
Under the proposed law, the patient would have to raise the issue of assisted dying with their doctor. This would provide an opportunity for the doctor to explore the underlying reasons for the patient’s request and might result in the patient’s care being changed to reflect their concerns. Alternatively, the patient might wish to proceed with their request for an assisted death, in which case the doctor would need to ensure they met the eligibility criteria to do so.

Two doctors would conduct the assessment of the dying patient. The first, or the attending doctor, would usually be the patient’s GP or specialist consultant, and the second doctor would be an independent doctor from a different practice or clinical team. The independent doctor would have to be suitably qualified in the diagnosis and management of terminal illnesses. Both doctors would examine the patient and their medical records and do so independently of each other. This would be done over a number of face-to-face consultations with the patient.

Where they thought it necessary, doctors could seek the opinion of other care professionals. For example, if they felt a more specialist assessment of mental capacity was required, a referral could be made to a psychiatrist or another suitably qualified professional.

If the patient was found to be eligible for, and still wanted, the choice of an assisted death, they would then sign a declaration. This would be countersigned by both doctors and witnessed by somebody who was not a relative and who had not been involved in the patient’s care.

The attending doctor would then write a prescription for the life-ending medication, which would be stored at a designated pharmacy. After a cooling-off period of fourteen days (or six days if the patient had a prognosis of less than one month), the patient would be able to contact the doctor and request the life-ending medication.

Either the attending doctor or an authorised ‘assisting health professional’ would pick up and deliver the medication to the patient. At the point of delivery, the doctor or care professional would ask the patient if they wished to revoke their request, and would remain close by (they could be in an adjacent room to allow for privacy). The patient would take the medication themselves, usually by mouth; if they were physically unable to do so, the assisting health professional could lawfully put the medication into a feeding tube or syringe driver but the patient would need to take the final act that controlled their death, e.g. activating the syringe driver.

If the patient chose not to take the life-ending medication at this point it would be returned to the pharmacy by the health professional.

The doctor would register the death and return monitoring paperwork as required under the law.

Other healthcare professionals
Any professional involved in a patient’s care might occasionally be approached by patients wanting to discuss assisted dying. If they were qualified to do so, these professionals could discuss the patient’s fears around death and dying and the treatment available to them. However, it would need to be made clear that if the patient wanted to take the process further and request an assisted death it would have to be discussed directly with their doctor.

Nurses
Nurses could be asked to contribute to doctors’ assessment of patients’ eligibility e.g. in assessing mental capacity or the possibility of coercion.

A nurse could be authorised by the attending doctor to act as the ‘assisting health professional’ and deliver the life-ending medication to the patient’s home when they requested it. The nurse would also check whether the patient still wanted to have an assisted death and would remain close by the patient until they had taken the medication and died, or until they had decided not to take the medicine.

Pharmacists
Once a prescription had been written by the attending doctor it would be sent to a local pharmacist. The medication would need to be available from the point where the patient’s cooling-off period finished.